1
|
Chang MC, Chen WC, Yu HC, Tsay FW, Chen YH, Wu CC, Lin KH, Hsu CW. Diving, lifting, and horizontal dissection followed by loop-clip traction (DLH+T) can facilitate mucosal flap creation during colorectal ESD. Surg Endosc 2022; 36:7811-7817. [PMID: 35648212 DOI: 10.1007/s00464-022-09324-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 05/01/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Colorectal ESD is difficult because of the poor maneuverability and difficulty of mucosal flap creation. Diving, Lifting and Horizontal (DLH) dissection technique and loop-clip traction are two different methods to facilitate mucosal trimming and adequate mucosal flap creation. We combined the advantages of these two techniques (DLH+T) in our daily practice colorectal ESD since July 2020. OBJECTIVE The purpose of this study was to examine the outcomes of DLH+T dissection compared with the conventional dissection. METHODS We retrospectively reviewed the clinical using DLH+T dissection compared with the conventional dissection since January 2018 at a single tertiary care institution. Postoperative short-term outcomes were investigated after the procedure including mucosal flap creation time, dissection time, dissection speed, en bloc resection rate, and perioperative complications. RESULTS 28 lesions were in DLH+T dissection group and 39 lesions in the conventional dissection group. The outcomes including en bloc resection rate, dissection speed, and complication between the two groups were similar. The mean mucosal flap creation time (p = 0.035) and the mean dissection speed (p = 0.041) of the DLH+T dissection group was significantly shorter and faster. CONCLUSION DLH dissection followed by loop-clip traction (DLH+T) technique is a useful technique for safe, efficient, and adequate mucosal flap creation, which can increase the dissection speed and may prevent complication, especially in biopsy-related submucosal fibrosis.
Collapse
Affiliation(s)
- Min-Chi Chang
- Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wen-Chi Chen
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Gastroenterology and Hepatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Hsien-Chung Yu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Gastroenterology and Hepatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Feng-Woei Tsay
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Gastroenterology and Hepatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yu-Hsun Chen
- Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chih-Chien Wu
- Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Kung-Hung Lin
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Gastroenterology and Hepatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chao-Wen Hsu
- Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan. .,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| |
Collapse
|
2
|
Chang CC, Chen WC, Tsay FW, Wang HM, Tsai TJ, Hsu CW. Pocket-creation colonic endoscopic submucosal dissection assisted by bidirectional double clip traction - A video vignette. Colorectal Dis 2022; 24:343. [PMID: 34821444 DOI: 10.1111/codi.16001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/14/2021] [Accepted: 11/20/2021] [Indexed: 12/26/2022]
Affiliation(s)
- Chun-Chia Chang
- Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wen-Chi Chen
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Gastroenterology and Hepatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Feng-Woei Tsay
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Gastroenterology and Hepatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Huay-Min Wang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Gastroenterology and Hepatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Tzung-Jiun Tsai
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Gastroenterology and Hepatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chao-Wen Hsu
- Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| |
Collapse
|
3
|
Chang MC, Tseng CL, Hsu CH, Chou CK, Hsu CW. Rubber band-clip traction for endoscopic submucosal dissection involving the appendiceal orifice - a video vignette. Colorectal Dis 2022; 24:243-244. [PMID: 34657364 DOI: 10.1111/codi.15958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 07/09/2021] [Accepted: 07/11/2021] [Indexed: 02/08/2023]
Affiliation(s)
- Min-Chi Chang
- Division of Colorectal Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chin-Lun Tseng
- Division of Colorectal Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chiao-Hui Hsu
- Division of Colorectal Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chu-Kuang Chou
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Chao-Wen Hsu
- Division of Colorectal Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| |
Collapse
|